Veterinary Clinical Medicine-I (General and Systemic)

II STAGE CARE : 36 HOURS AFTER ARRIVE TO 5 DAYS 

• This period of time is a transition from flow phase of shock to the hypermetabolic phase. The main problems in this stage are:
  • Pulmonary problems
  • Hemodynamic stability
  • Proper care of burn wounds
  • Pain and anxiety control
• The main pulmonary problems come up from airway obstruction due to thermal or chemical burn of the airway mucosa. Adequate laryngoscopy is very helpful to assess the real damage. Long term intubation should be considered, if mechanical ventilation is available.
• Cough and increased mucous production are very common in this period, related to mucosal irritation. However, the damage and impairment of ciliary function, leads to infections as: bacterial tracheobronchitis, pneumonia or bronchopneumonia. Proper antibiotic selection trough culture of secretions are the first choice for this complications.
• Evaporation is a major source of water loss within the burn wounded areas. An estimation of the loss must be obtained to perform proper fluid therapy. Anemia is another complication caused by red cells destruction plus bone marrow impaired production.
• Fluid therapy is a keystone during this period of time. Fluids with 5% glucose with small amount of sodium are indicated because there are no major losses of sodium during this stage. No aggressive fluid therapy are currently indicated: 60-70 mmHg as mean arterial pressure, checking urine production around 1-2 ml/Kg/ hour. Albumin level around 2,5 g/dL is the goal, with hematocrit should be kept over 30%, considering whole blood transfusion.
• It is important to remember that burn animals has major effects over the immune system, associated to impaired cell mediated immunity, decrease in the neutrophil function, and compromise of the humoral immune response. With all these effects, infection should be a major complication in the wounds care. Culture, biopsy analysis and antibiotic studies must be performed in order to specific control over infection. Wound cleaning, excision and escharotomy are regular that procedures, can be used to obtain proper samples for culture.
• Careful handling of stress, anxiety and pain are extreme important in the small animal burn patient: narcotics as morphine, oxymorphine, butorphanol and low doses of benzodiazepines are indicated. Phenothiazines must be avoided because their extrapyramidal side effects in burn patients.